胸部CT检查在新型冠状病毒肺炎患者筛查中的应用

doi:10.3969/j.issn.2095-9400.2020.03.002

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摘要目的：探讨胸部CT检查在新型冠状病毒肺炎患者筛查中的应用及重要性。方法：回顾性分析2020年1月19日至2月1日经温州医科大学附属第一医院和温州医科大学附属第二医院核酸检测阳性确诊的新型冠状病毒肺炎患者35例，分为CT阳性组（肺部有渗出）31例和阴性组（肺部无渗出）4例。记录其流行病学史、临床症状、白细胞计数及淋巴细胞计数异常患者数量以及在2组的分布情况，探讨CT阳性组的病灶位置、分布及形态学特征。结果：在所有35例患者中，CT阳性患者占88.6%（31/35），武汉旅居史占31.4%（11/35），本地确诊患者接触史占31.4%（11/35），无明确流行病史占37.1%（13/35），发热占88.6%（31/35），胃肠道症状占11.4%（4/35），白细胞计数下降占17.1%（6/35），淋巴细胞计数下降占37.1%（13/35）。CT阳性组发病时间4（2，7）d，明显大于CT阴性组的2（1，2）d，差异有统计学意义（P=0.027）。31例CT阳性组新型冠状病毒肺炎患者中两肺分布29例（占93.5%）。31例患者共计471个渗出灶：病灶下肺分布占67.3%（318/471），其他肺叶分布占36.7%（173/471）；肺野周边分布占75.4%（355/471），背侧分布占76.4%（360/471）。所有病灶中，4.9%（23/471）伴有晕征，铺路石征占2.5%（12/471），反晕征占1.9%（9/471）。12.9%（4/31）患者伴微少量胸水（双侧2例，单侧2例）。结论：胸部CT检查对新型冠状病毒肺炎患者的筛查具有重要意义，发病早期尤其是发热时间≤2 d的患者胸部CT检查可为阴性。

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关键词 ：新型冠状病毒肺炎, 体层摄影术, X线计算机, 筛查

Abstract：Objective: To explore the application and importance of chest CT in screening COVID-19 patients. Methods: A total of 35 COVID-19 patients from the First Affiliated Hospital of Wenzhou Medical University and the Second Affiliated Hospital of Wenzhou Medical University between January 19th and February 1st, 2020 were divided into CT-positive group (with lung exudation, n=31) and CT-negative group (no lung exudation, n=4). The epidemiological history, clinical symptoms, white blood cell count, and lymphocyte count abnormality in each patient were prospectively recorded, and their clinical features were evaluated. The location, distribution and morphological characteristics of lesions in CT positive group were investigated. Results: Of 35 COVID-19 patients, CT-positive patients accounted for 88.6% (31/35), with a history of the endemic center Wuhan contact accounting for 31.4% (11/35), local confirmed patients contact 31.4% (11/35), no clear epidemiological history 37.1% (13/35), fever 88.6% (31/35), gastrointestinal symptoms 11.4% (4/35), decreased white blood cell count 17.1% (6/35) and decreased lymphocyte count 37.1% (13/35). The median onset time in the CT-positive group was 4 (2, 7) d, significantly longer than CT-negative group of 2 (1, 2) d (P=0.027). Among the 31 COVID-19 patients with CT-positive, 29 (93.5%) had bilateral lung distribution. There were 471 lesions in 31 COVID-19 patients, including 67.3% (318/471) lesions located in the lower lung, and 36.7 % (173/471) in other lung lobes; 75.4% (355/471) in the lung peripheral field, and 76.4% (360/471) in the posterior lung. Of all lesions, 4.9% (23/471) had halo sign, 1.9% (9/471) reverse-halo sign, 2.5% (12/471) paving stone sign. In addition, 12.9% (4/31) of the patients were accompanied by a small amount of pleural effusion (2 cases bilateral and 2 cases unilateral). Conclusion: Chest CT examination is of great significance for the screening of patients with new type of coronavirus pneumonia, but chest CT examination of early symptoms with fever ≤2 d may be negative.

Key words： COVID-19 tomography, X-ray computed screening

基金资助:浙江省医药卫生科技计划项目（2019KY102）；温州市科技局科研基金资助项目（2018Y0144）。

通讯作者: 夏景林，教授，主任医师，Email：xiajinglin@fudan.edu.cn。

作者简介: 傅钢泽（1985-），男，浙江温州人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.03.002 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I3/177

[1] HUANG C, WANG Y, LI X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395(10223): 497-506.
[2] LI Q, GUAN X, WU P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia[J]. N Engl J Med, 2020, 382(13): 1199-1207.
[3] WU P, HAO X, LAU E H Y, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan China, as at 22 January 2020[J]. Euro Surveill, 2020, 25(3): pii=2000044.
[4] CHAN J F, YUAN S, KOK K H, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster[J]. Lancet, 2020, 395(10223): 514-523.
[5] NISHIURA H, JUNG S M, LINTON N M, et al. The extent of transmission of novel coronavirus in Wuhan, China, 2020[J]. J Clin Med, 2020, 9(2): 330.
[6] CHAN J F, KOK K H, ZHU Z, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan[J]. Emerg Microbes Infect, 2020, 9(1): 221-236.
[7] ZHU N, ZHANG D, WANG W, et al. A novel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020, 382(8): 727-733.
[8] WANG W, TANG J, WEI F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China[J]. J Med Virol, 2020, 92(4): 441-447.
[9] 雷子乔, 史河水, 梁波, 等. 新型冠状病毒(2019-nCoV)感染的肺炎的影像学检查与感染防控的工作方案[J]. 临床放射学杂志, 2020, DOI: 10.13437/j.cnki.jcr.20200206.001.
[10] 郑颖彦, 马昕, 王慧英, 等. 新型冠状病毒肺炎的CT征象[J/OL]. 上海医学, 2020[2020-02-01]. http://kns.cnki.net/kcms/detail/31.1366.r.20200209.1042.002.html.
[11] 史河水, 韩小雨, 樊艳青, 等. 新型冠状病毒(2019-nCoV)感染的肺炎临床特征及影像学表现[J]. 临床放射学杂志, 2020. DOI: 10.13437/j.cnki.jcr.20200206.002.
[12] CORMAN V M, LANDT O, KAISER M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR[J]. Euro Surveill, 2020, 25(3): pii=2000045.
[13] LEE N, HUI D, WU A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong[J]. N Engl J Med, 2003, 348(20): 1986-1994.
[14] WONG K T, ANTONIO G E, HUI D S, et al. Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients[J]. Radiology, 2003, 228(2): 401-406.
[15] AJLAN A M, AHYAD R A, JAMJOOM L G, et al. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings[J]. AJR Am J Roentgenol, 2014, 203(4): 782-787.